Low birth weights and risk of neonatal mortality in Indonesia

Vol. 7, No. 2, December 2016 Low birth weight and neonatal mortality in Indonesia

Low birth weights and risk of neonatal mortality in Indonesia

1 Suparmi, Belinda Chiera, Julianty Pradono

1 National Institute of Health Research and Development, Ministry of Health, Jakarta, Indonesia

2 School of Information Technology and Mathematical, University of South Australia

Corresponding address: Suparmi, SKM., MKM e-mail: suparmi@litbang.depkes.go.id Received: October 11, 2016; Revised: November 21, 2016; Accepted: Desember 5, 2016

Abstrak

Latar Belakang: Angka kematian neonatal di Indonesia mengalami stagnansi sejak sepuluh tahun

terakhir. Dalam rangka mengakselerasi penurunan angka kematian neonatal di Indonesia, intervensi

spesifik diperlukan pada faktor utama penyebab kematian. Penelitian ini bertujuan untuk mengetahui

kontribusi berat badan lahir rendah terhadap kematian neonatal di Indonesia.

Metode: Data Survei Demografi dan Kesehatan Indonesia tahun 2012 digunakan untuk analisis. Sejumlah

18021 kelahiran hidup dalam periode lima tahun terakhir telah dilaporkan oleh responden. Terdapat

14837 anak memiliki informasi lengkap untuk analisis. Adjusted relative risk dengan analisis survival

digunakan untuk mengukur hubungan antara variable dengan kematian neonatal.

Hasil: Anak yang lahir dengan berat badan rendah memiliki risiko 9.89 kali lebih tinggi untuk kematian

neonatal bila dibandingkan dengan anak yang lahir dengan berat badan normal [adjusted relative risk

(aRR) = 9.89; 95% confidence interval (CI): 7.41 – 13.19); P = < 0.0001]. Anak yang lahir dari ibu

berumur muda (15 - 19 tahun) memiliki risiko 94% lebih tinggi bila dibandingkan dengan anak yang

lahir dari ibu dengan umur antara 20-35 years. Anak dari ibu yang bekerja 81% memiliki risiko kematian

neonatal lebih tinggi bila dibandingkan dengan anak yang lahir dari ibu tidak bekerja.

Kesimpulan: Anak yang lahir dengan berat badan rendah dan lahir dari ibu muda memiliki risiko kematian

neonatal lebih tinggi. Bayi yang lahir dengan berat badan rendah membutuhkan perawatan yang tepat

untuk memperpanjang ketahanan hidup anak. (Health Science Journal of Indonesia 2016;7(2):113-7)

Kata Kunci:

Berat badan lahir rendah, kematian neonatal, Indonesia

Abstract

Backgrounds: Neonatal mortality rates in Indonesia remain steady in the past decades (20 in 2002 to 19

per 1000 live births in 2012). In order to accelerate the decline in neonatal mortality rate in Indonesia,

study aims to examine specific interventions would have to target key factors causing mortality. This contribution of low birth weight on neonatal mortality in Indonesia.

Methods: Data from the Indonesia Demographic and Health Survey (IDHS) conducted in 2012 were used

in the analysis. A total of 18021 live births in the last five years preceding the survey were reported from

the mothers . Completed information of their children (14837 children) were taken for this ana lysis. The

adjusted relative risk with cox proportional hazard regression analysis were used to assess the strength of

association to neonatal mortality.

Results: 9-fold higher risk of neonatal mortality compared to

Children born in low birth weight were 9.8

children born in normal weight [adjusted relative risk (aRR) = 9.89; 95% confidence interval (CI): 7.41 –

from

13.19); P = < 0.0001]. Children delivered younger mothers (aged 15 - 19 years) had 94% higher risk

of neonatal mortality compared to children delivered from mothers aged 20-35 years. Working mothers

had 81% higher risk of neonatal mortality compared to unemployed mothers.

Conclusions:

Children born in a low birth weight and born from younger mothers had higher risk of

neonatal mortality. Appropriate care and treatment for children born in low birth weight is needed to

prolonged survival rates of the children. (Health Science Journal of Indonesia 2016;7(2):113-7) Keywords:

Health Science Journal of Indonesia Suparmi et al.

6,7

As shown in Table 1, out of 14837 children, nearly 51% lived in rural areas and they were almost equally between male and female. About 30% of the children came from the poorest household and more than half of the mothers had complete secondary education. Table 1 also revealed that more than half of the mothers were working and most of them aged between 20 to 35 years old. Table 1 shows percentage of neonatal mortality by socio- demographic characteristics and pregnancy history of mothers. As shown in Table 1, male children were more likely to have higher risk of neonatal mortality compared to female children. Neonatal mortality was similarly distributed in terms of history of delivery complication, place of delivery, type of delivery, mother’s education, socio-economic status and type of residence.

9 The analysis used STATA 12.0 software.

variables that were significantly associated with the study outcomes. The adjusted relative risk with 95% confidence intervals were calculated to assess the strength of association, and those relative risk with p < 0.05 were retained in the final model.

regression analysis was used to identify independent

Estimation of neonatal and under-five mortality rates were calculated for live births in the last five years preceding the survey. Frequency tabulations were then conducted to show the distribution of the data and followed by the contingency table analysis to examine the impact of potential predictors on neonatal and child mortality without adjusting for other covariates. A backwards stepwise cox proportional hazard

delivery complication, place of delivery, type of delivery, mother’s age, mother’s occupation, mother’s education, household wealth status and residence.

The outcomes of the analysis were neonatal and under-five mortality rates. The neonatal mortality rates defined as the number of children died before reaching 28 days of age per 1000 live births. While the under-five mortality defined as the number of children died before reaching exact age 5. In these analyses, the outcomes were recorded as a binary variable (0=Alive and 1=Died). Potential predictors variables included in the analysis were birth weight, gender,

2 Out of them, 14837 children completed information for the analysis.

The analysis was conducted in 2016 derived from the 2012 Indonesia Demographic and Health Survey (IDHS) data. The 2012 IDHS was designed to produce estimates of health indicators at the national, urban-rural, and provincial levels. A total of 46,024 households were selected in the sample, of which 44,302 were occupied. Of these households, 43,852 were successfully interviewed, resulting in a 99% household response rate. In the interviewed households, 47,533 women were identified as eligible for individual interview and of these candidates completed interviews were conducted with 45,607 of 18,021 live births in the last five years preceding the survey were reported by the mothers.

in neonatal mortality reduction. Therefore, this study aims to examine the contribution of low birthweight on neonatal mortality in order to accelerate the decline in neonatal mortality rate in Indonesia.

8 This may account for lack of improvement

Around 10.2% of children in Indonesia born in low birth weight.

Low birth weights (with or without prematurity) decrease the odds of the children surviving in the first months of live.

The fourth Millennium Development Goal (MDG-4) targeted to reduce under-five mortality by two-third between 1990 to 2015. Globally, under-five mortality rate had been reduced by 53% since 1990.

4,5

development and future risk of chronic disease.

Several studies have shown low birthweight closely associated with neonatal mortality and affect child

Disparities across provinces and districts occur due to social stratification, ecological-cultural diversity, and Indonesia’s large geographical area. In addition, Indonesia has a complex health system, including the decentralization of health at the district level.

3 The eastern provinces tend to have higher neonatal mortality rates compared to the western area.

widening inequity across geographic and socio- demographic groups remains a concern in Indonesia.

2 The slow decline of neonatal mortality and a

in Indonesia remained steady in the past decades (20 in 2002 to 19 per 1000 live births in 2012).

1 In addition, neonatal mortality rates

children died before complete age of five and around 41.6% of under-five mortality occur in the first months (neonatal period).

2 However, it was estimated that 6.3 million

has greater decline of under-five mortality which around 59 percent, from 97 deaths per 1,000 live births in the IDHS 1991 to 40 deaths per 1,000 live births in IDHS 2012.

1 Indonesia

RESULTS

METHODS

Vol. 7, No. 2, December 2016 Low birth weight and neonatal mortality in Indonesia Table 1. Socio-demographic, pregnancy history and risk of neonatal mortality

Not working

98.7

1.4 1.05 0.80 - 1.39 0.720

1.3 1.00 reference Rural 7,168 98.6 101

Urban 7,468 98.7 100

1.0 0.60 0.38 - 0.95 0.029 Type of residence

99.0

1.3 0.75 0.49 - 1.14 0.175 Richest 2,587

1.5 0.87 0.58 - 1.29 0.480 Richer 2,833

Variables Alive Death

98.5

1.2 0.68 0.45 - 1.04 0.073 Middle 2,912

98.8

1.7 1.00 reference Poorer 3,034

98.3

Table 2. Low birth weight and risk of neonatal mortality

P n % n

Adjusted Odds Ratio 95% Convidence Interval

1.2 1.00 reference 36-49 3,067

1.7 1.81 1.34 - 2.44 0.000

1.0 1.00 reference Working 7,683 98.3 132

99.0

6,953

1.7 1.24 0.90 - 1.72 0.195 Mothers occupation

98.3

2.5 1.94 1.02 - 3.68 0.043 20-35 11,133 98.8 138

0.8 0.43 0.13 - 1.48 0.182 Socio-economic status

97.5

15-19 436

7.8 9.89 7.41 - 13.19 0.000 Mother’s age

92.2

0.8 1.00 reference 2500 - 8000 1,004

99.2 116

% Birth Weight (grams) 500 - 2499 13,632

Poorest 3,270

Variables Alive Death

1.2 1.00 reference Yes 6,686 98.5 101

1.3 1.00 reference C-section 2,012

Normal/others 12,624 98.7 166

1.5 1.34 0.99 - 1.82 0.058 Type delivery

1.1 1.00 reference Health facilities 9,393 98.5 142

98.9

Home/others 5,243

1.5 1.20 0.91 - 1.59 0.197 Place delivery

No 7,950 98.8 100

1.6 1.45 1.09 - 1.92 0.011 Delivery complication

1.1 1.00 reference Male 7,558 98.4 122

98.9

Female 7,078

% Gender of the children

P n % n

95% Confidence Interval

Crude Odds Ratio

98.3

1.7 1.32 0.92 - 1.91 0.136 Mother’s age

99.3

1.0 Working 7,683 98.3 132

1.5 0.87 0.27 - 2.75 0.806 Higher 2,262

1.4 0.82 0.25 - 2.64 0.739 Secondary 8,284 98.5 125

98.6

1.7 1.00 reference Primary 3,918

98.3

No education 172

1.7 1.73 1.29 - 2.32 0.000 Mother’s education

15-19 436

99.0

6,953

1.7 1.37 0.99 - 1.88 0.056 Mothers occupation

98.3

1.2 1.00 reference 36-49 3,067

2.5 2.04 1.09 - 3.79 0.025 20-35 11,133 98.8 138

97.5

Not working

Health Science Journal of Indonesia Suparmi et al.

14 The World Health Organization promotes essentials

In order to provide equal child care between employed and unemployed mothers, child day care should be existing in workplace. Furthermore, we suggest to ensure working mothers to have proper maternity leaves to provide better child care in early lives.

19,20

of delayed marriage and improved contraceptive use among younger mothers in order to reduce neonatal mortality rates in Indonesia. Our findings report mother’s occupation is also a risk factor in neonatal mortality. Similar to our findings, a study in India revealed that unemployed mothers had lower odds of neonatal mortality.

18 This result suggests the important

likely than older mother to give adequate prenatal care to the children.

17 The younger mother was less

Further systematic review suggests difficulties of younger mother to access health facilities due to stigmatization and negative attitude from health providers.

16,17

was a biological effect mediated by the mother’s physiological immaturity.

15 The risk of a younger mother

In conclusion, in this study, we found that children born in a low birth weight and born from younger mothers had higher risk of neonatal mortality. Specifically, for mothers aged less than 20 years old had high neonatal mortality. A further study to understand nature of adolescence pregnancy in Indonesia is required.

The final model showed that birth weight, mother’s

DISCUSSION

and advocate appropriate care for preterm birth is important to reduce neonatal mortality. The kangaroo mother care can be an option for neonatal care with low birth weights; to put skin- to-skin contact between a mother and her newborn.

surviving mothers were interviewed, which may lead underestimate of neonatal mortality. Second, limitation of this study were related to recall bias. Estimation of neonatal mortality based on survey may also suffer from mothers misreporting their children’s birth dates, current age or age at death. Our study suggests that low birth weight has significant impact on neonatal mortality. These findings suggest an appropriate care and treatment for children born in low birth weight are needed to prolonged survival rates of the children, including kangaroo mother care for newborn care intervention.

need to improve mother care during pregnancy and child birth, particularly of low birth weight infants. Improving supplementation for chronic maternal nutritional deficiencies

12 These findings suggest the

low birth weights include preterm births and small for gestational age.

11 Some of common reasons of

weight remained as a strong predictor after adjusted for several confounders, with the odds for neonatal death for low birth weight infants (<2500 grams) was 5.5 times higher than the normal weight infants (2500 – 3500 grams).

11 The birth

, suggest that low birth weights had negative and direct relationship on infant mortality rates. The similar result also shown in further analysis of DHS 2002-2003 Indonesia.

Our analysis showed that low birth weights increased the risk of neonatal mortality. Previous study in neonatal intensive care unit of Alzahra Educational- Medical centre Iran

Our final model also revealed that children delivered from younger mothers (aged 15 - 19 years) had 94% higher risk of neonatal mortality compared to those delivered from mothers aged 20-35 years [adjusted relative risk (aRR) = 1.94; 95% confidence interval (CI): 1.02 – 3.68)]. Furthermore, mother’s working status were associated to neonatal mortality. Working mother had 81% higher risk of neonatal mortality compared to unemployed mothers [adjusted relative risk (aRR) = 1.81; 95% confidence interval (CI): 1.34 – 2.44)].

neonatal mortality (Table 2). Low birth weights were risk factors of neonatal mortality. Children born in low birth weight had a 9.89-fold higher risk of neonatal mortality compared to children born in normal weight range [adjusted relative risk (aRR) = 9.89; 95% confidence interval (CI): 7.41 – 13.19)].

age and mother’s occupation were associated with

21 The study had several limitations. First, only

Acknowledgments

had higher risks of neonatal mortality. Studies increase in mothers age is associated with child mortality reduction.

The author would like to thank the Department of Foreign Affairs and Trade (DFAT) and University of South Australia for the support of conducting this analysis through the Short Term Awards (STA) on Quantitative

newborn care and developed clinical guidelines in order to prolonged newborn survival.

12 Children delivered from mothers aged 15-19 years

Vol. 7, No. 2, December 2016 Low birth weight and neonatal mortality in Indonesia

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Low birth weights and risk of neonatal mortality in Indonesia